学龄期注意缺陷多动障碍儿童社交焦虑现状及影响因素

Status quo and its influencing factors of social anxiety in school-age children with attention deficit hyperactivity disorder

目的调查注意缺陷多动障碍(ADHD)儿童社交焦虑现状,分析影响ADHD儿童社交焦虑的因素,为完善ADHD患儿临床管理提供参考。方法选取2020年1月—2023年1月绵阳市中心医院接诊的206例学龄期ADHD患儿,采用一般资料调查问卷收集儿童相关临床资料,儿童社交焦虑量表(SASC)评估社交焦虑,社会反应量表(SRS)评估社交能力,中文版注意缺陷多动障碍评定量表(SNAP-Ⅳ)评估核心症状。采用多因素Logistic回归分析影响ADHD患儿社交焦虑的因素。结果206例ADHD患儿中128例(62.14%)存在社交焦虑,SASC得分为(14.02±4.06)分。焦虑组女童(χ^(2)=6.057)、共患孤独谱系障碍(ASD)(χ^(2)=4.929)、主要照顾者初中及以下文化程度的比例(χ^(2)=13.345),SRS(t=5.842)和SNAP-Ⅳ总分(t=7.848)以及各维度评分均高于无焦虑组(P<0.05)。多因素Logistic回归分析显示高SRS总分(OR=5.217,95%CI:2.309~11.791)、高SNAP-Ⅳ总分(OR=4.150,95%CI:1.974~8.722)、女童(OR=2.268,95%CI:1.423~3.616)、主要照顾者初中及以下文化程度(OR=1.527,95%CI:1.162~2.005)、共患ASD(OR=1.551,95%CI:1.209~1.990)是ADHD患儿发生社交焦虑的危险因素(P<0.05)。结论ADHD患儿社交焦虑发生率较高,针对高风险患儿应加强认知行为治疗和心理干预,以提高社交能力,降低社交焦虑风险。

Objective To investigate the current situation of social anxiety in children with attention deficit hyperactivity disorder(ADHD),and to analyze the factors influencing social anxiety in ADHD children,in order to provide reference for improving the clinical management of ADHD children.Methods A total of 206 school-age children with ADHD were selected from the Children's Psychology Clinic of Mianyang Central Hospital from January 2020 to January 2023.The relevant clinical data of the children were collected through the general data questionnaire.Children's Social Anxiety Scale(SASC)was used to assess social anxiety,and the Social Response Scale(SRS)was used to assess social ability.The Chinese version of Swanson,Nolan and Pelham Rating ScaleⅣ(SNAP-Ⅳ)was used to assess core symptoms.Multivariate Logistic regression analysis was used to determine influencing factors of social anxiety in children with ADHD.Results There were 128(62.14%)cases detected with social anxiety among 206 children with ADHD.The score of SASC was 14.02±4.06.The proportions of girls(χ^(2)=6.057),comorbid autism spectrum disorder(ASD)(χ^(2)=4.929),and main caregivers with junior high school education or below(χ^(2)=13.345),the total score of SRS(t=5.842)and SNAP-Ⅳ(t=7.848)and the scores of all dimensions were significantly higher than those in the non-anxious group(P<0.05).Multivariate Logistic regression analysis showed that higher SRS total score(OR=5.217,95%CI:2.309-11.791),higher SNAP-Ⅳtotal score(OR=4.150,95%CI:1.974-8.722),girls(OR=2.268,95%CI:1.423-3.616),primary caregivers with junior high school education or below(OR=1.527,95%CI:1.162-2.005),and comorbid ASD(OR=1.551,95%CI:1.209-1.990)were risk factors for social anxiety in ADHD children(P<0.05).Conclusions Children with ADHD have a higher prevalence rate of social anxiety.Cognitive behavioral therapy and psychological intervention should be strengthened for high-risk children to improve social ability and reduce the risk of social anxiety.